Breastfeeding

Breastfeeding is the best way to feed a baby and has short and long term benefits for both mother and baby

Breastfeeding mothers need

• Support from family, partner, friends and clinic staff

• Time to rest and enjoy baby

• Healthy foods — including water, bush foods, vegetables, fruit, breads, cereals, meats

• To avoid smoking, alcohol and other substances

Supporting breastfeeding

• Keep baby and mother together after birth and in early days and weeks of life to enable breastfeeding and bonding
• Promote skin-to-skin contact between mother and baby throughout the postnatal period, especially before and after breastfeeding
• Encourage mother to recognise when baby ready to breastfeed — Figure 4.3. Offer help if needed

Baby feeding cues © State of Queensland (Queensland Health)

Breastfeeding assessment

• Offer a private space to do a breastfeeding assessment
• Ask about breastfeeding history and any current problems
• Check breasts for abnormalities, trauma or other issues — See Breastfeeding — common issues
• Observe a breastfeed to check positioning, latch and that baby has an effective suck and swallow
• Allow mother to position and adjust baby

Positioning baby

• Make sure mother is comfortable and can see her breast as baby latches 
• Unwrap baby so arms and hands are out and able to move and mother and baby have skin to skin contact
• Mother brings baby close to her body
• Tummy to tummy — baby's head and shoulders facing breast
• Bottom tucked into mother's tummy, nose out
• Baby's nose and mouth at level of mothers nipple
• Mother supports baby behind shoulder/neck area — Figure 4.6
  
• Avoid grasping or holding baby's head to position baby at breast

• Mother touches baby’s cheek with nipple to encourage baby to open mouth
• When baby’s mouth wide open and tongue down, mother can move baby toward her breast, baby’s mouth to her nipple
• Reassure mother it may take a few tries to attach baby to breast
• Different positions may help baby to get attached and feeding

How to know breastfeeding is going well

• Mother responds to baby's hunger signs — see Table 4.3 
• Baby has at least 8-10 feeds every day and feeds for 10-40 minutes each breastfeed
• Baby cannot be overfed on breast milk, will drink the right amount for good growth
• If baby sick or not feeding well, it might not feed as long as it needs to
• Baby wakes themselves when wanting a breastfeed and is content after feeding
• Mother feels breasts soften during and after feeding
• Baby passes around 6 wet nappies each day
• Baby is growing well (weight and length)

If help needed

• Refer to midwife/lactation consultant for help if mother, family or clinic staff worried
• Early referral can reduce long term feeding problems
• Check for and treat breastfeeding issues — See Breastfeeding — common issues
• Medical consult for mother and baby

Expressing and storing breast milk

• Breastfed baby may need to be looked after by someone else (eg if mother goes to hospital)
• Mother may also express breast milk for sick or preterm baby
• If baby is very young — encourage mother to express enough breast milk to give baby for the time she will be away and to continue to express when away from baby
• No other drinks or food should be given to young baby — See Postnatal nutrition for mother and baby (up to 6 months old)
• Older baby may be having other food or water. Give these until mother returns
• Can hand express — Figure 4.7 or use manual or electric breast pump — Figure 4.8
• Support mother with expressing — make sure she has the correct information and help, advise her that baby will continue to have the benefits of breast milk
• Midwife/lactation consultant can help if needed

• Store breast milk in clean, sealed plastic container
• Fridge — up to 72 hours at the back where it is coldest and not in the door
• Freezer inside fridge — up to 2 weeks
• Freezer compartment of fridge (with separate door) — up to 3 months
• Deep freeze — 6–12 months
• Expressed milk separates into layers. Shake container before giving to baby
• Warm bottle of breast milk in hot water if needed. Warm to body temperature only
• Fine to use thawed and doesn't have to be warmed
• Do not use microwave to thaw or heat milk
• Talk with midwife or lactation consultant for more information

Special circumstances

Medicines

• Do not give medicine to breastfeeding mother without checking it is safe — check with doctor or midwife, a medicine reference book or contact your closest Pregnancy Drug Information Centre for more information

Preterm babies

• Breast milk is especially good for preterm, small, sick babies
• If baby not able to breastfeed — try other methods of giving breast milk
• Express into baby’s mouth, cup feeding, finger feeding — refer to midwife/lactation consultant

Maternal blood-borne viruses

• Sometimes mother advised not to breastfeed or to breastfeed for a short time only to lessen risk of passing virus to baby (eg HIV or HTLV1 positive — See Human T Cell Leukaemia Virus type 1 (HTLV-1))
• Talk with local public health unit, sexual health specialist, paediatrician and lactation consultant to make individual breastfeeding plan
• Mothers with syphilis, hepatitis A, hepatitis B, hepatitis C can breastfeed their babies
• If hepatitis C positive and cracked or bleeding nipples — advise to express and discard milk until bleeding areas healed
• Talk with someone experienced in this area — PHU or lactation consultant

Alcohol and other substances

• Usually best for baby to breastfeed even if mother smoking or drinking alcohol
• Advise mothers
• Not drinking alcohol is the safest option when breastfeeding
• Baby will get alcohol and other substances through her breast milk.
• Nicotine may reduce milk production
• Adult who has been drinking alcohol should not sleep next to baby
• Talk about best way to take care of baby if she is drinking. Ask about family support and involve other services for help
• If mother does drink, advise to
  
• Avoid drinking immediately before breastfeeding
• Think about expressing milk in advance if she is planning to drink
• Limit alcohol to no more than 2 standard drinks a day
• If mother does smoke, advise
  
• Keep baby away from passive smoke. Don't smoke just before or while breastfeeding

Older babies

• Exclusive breastfeeding for about the first 6 months is best for all babies. This means breast milk only — no other food or drink, not even water
• At around 6 months — start healthy iron-rich solid foods and boiled and cooled water in a cup — See Infant, child, youth growth (0-17 years)
• Continue to breastfeed until 1–2 years or longer if mother and baby want — any breast milk is good for older babies and prevents infections

Next pregnancy and new baby

• Some women keep feeding older child when pregnant with another baby. Usually quite safe and should be supported
• Some mothers continue feeding older child after new baby is born. May feed babies together or at different times
• Important that new baby is fed first and has plenty of time at the breast
• Usually enough milk for both but growth of both children, especially new baby needs to be monitored
• Toddlers can be very demanding so woman needs to understand that new baby must not miss out on feeding
• New baby needs to put on at least 150–200g each week. If growth poor — urgent medical consult
  

Suppressing lactation

• Woman may want to stop milk supply (eg very sick, baby died or given to someone else)
• Women start making milk at about 20 weeks pregnant so mother may need help with suppressing even after loss of very preterm baby
• Advise minimal handling of breasts (avoid massage or stimulation) and wear a firm bra
• If has been breastfeeding — may need to express some milk for comfort and decrease over few days until milk supply decreases
• May take a few days. Advise to take paracetamol OR ibuprofen — See Pain management (acute)
• If concerns medical consult and talk with midwife or lactation consultant

Supporting resources

• Australian Breastfeeding Association website
• Raising children network website